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Claims Senior Representative-Bodily Injury

2 months ago

Ashley, United States Westfield Full time
Job Description

The Claims Senior Representative serves as a technical expert on claims adjusting and handles injury, material damage, negligence, compensability, damage, and coverage issues. The role focus is on evaluating and resolving both Personal Lines and Commerical lines injury claims The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team.

Responsibilities

  • Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions on claim resolution.
  • Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker.
  • Determines the value of the physical damage of property, automobiles, or injuries through appropriate tools, recognizes claim file exposures and escalates appropriately.
  • Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies.
  • Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets.
  • Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards.
  • Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience.
  • Identifies and refers all claims to management for further handling and assignment instructions.
  • Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations.
  • Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing.
  • Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines.
  • Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel.
  • Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation.
  • Interprets complex and detailed documents such as contracts, legal documents, medical reports, insurance regulations and policies as needed.
  • Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices.
  • For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned.
Qualifications
  • 4+ years of Claims Handling experience.
  • Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience.
  • For field roles only: Valid driver's license and a driving record that conforms to company standards.